Abstract
Title. Nurses’ responses to ethical dilemmas in nursing practice: meta-analysis.
Aim. This paper is a report of a study to explore nurses’ responses to ethical
dilemmas in daily nursing practice.
Background. Concern about nurses’ ethical competence is growing. Most nurses
perceived that there were barriers in their work environment to ethical practice,
compromising their ability to perform ethically. Since most research focuses on
contextual barriers to nurses’ ethical practice, little is known about how nurses
involve themselves in ethical decision-making and action in daily care.
Method. A meta-analysis of nurses’ ethical behaviour was conducted using data
from nine studies in four countries (n = 1592 registered nurses). In all studies, the
Ethical Behaviour Test was used to measure nurses’ ethical responses, based on an
adapted version of Kohlberg’s theory of moral development. Data were analysed
using random-intercept regression analysis.
Findings. All groups, except the expert group, displayed a uniform pattern of
conventional ethical reasoning and practice. When nurses were faced with ethical
dilemmas, they tended to use conventions as their predominant decision-guiding
criteria rather than patients’ personal needs and well-being.
Conclusion. Conformist practice (following conventions rather than pursuing good
for the patient) constitutes a major barrier for nurses to take the appropriate ethical
actions, as creativity and critical reflection are absent. There is an urgent need to find
ways to promote nurses’ ethical development from conventional to postconventional
ethical practice. More research is needed to strengthen existing empirical evidence